Pathway of azygous vein in the thorax - correct answer runs along R side and dumps into superior vena
cava
Pathway of thoracic duct in the chest - correct answer runs along R side, crosses midline at T4-T5, goes
into L neck and dumps into L subclavian vein at junction with LIJ
Pathway of phrenic nerve in thorax - correct answer runs anterior to hilum
Pathway of vagus nerve in thorax - correct answer runs posterior to hilum
What fissures exist in the lungs? - correct answer Major oblique separates RLL from middle and upper
lobe
Minor separates upper from middle lobe
Muscle used in quiet respiration - correct answer Diaphragm 80%, intercostals 20%
Accessory muscles of respiration - correct answer SCM
Levators
Serratus posterior
Scalenes
Main surface active agent in surfactant - correct answer phosphatidylcholine
,Thoracic - TCAR
Alveolar, arterial, and venous pressures in lung zones in upright person - correct answer Zone I: PA > Pa >
Pv
Zone II: Pa > PA > Pv
Zone III: Pa > Pv > PA
Normal pulmonary artery pressure - correct answer 25/10 (mean 15)
What predicted value is needed for pulmonary resection? - correct answer Predicted postop FEV1 > 0.8L
(>40% predicted)
What can be done if the predicted postop FEV1 is close to 0.8 (40% predicted)? - correct answer Obtain a
V/Q scan and see how much that segment actually contributes
Single best predictor of being able to wean off ventilator after pulmonary resection - correct answer
FEV1
Minimum DLCO for lung resection - correct answer >11-12 ml/min/mmHg CO (>50% predicted value)
What six things effect DLCO? - correct answer Pulmonary capillary surface area
Hgb
Alveolar architecture
Dead space
Low CO
Pulmonary HTN
What pCO2 is necessary for lung resection? - correct answer <45 at rest
What pO2 is necessary for lung resection? - correct answer >60 at rest, not on O2
, Thoracic - TCAR
What VO2max is needed for lung resection? - correct answer >10 ml/kg/min (maximum o2
consumption)
DLCO >11-12 ml/min/mmHg CO (>50% predicted, or 40% postop)
pCO2 <45 at rest
pO2 >60 at rest, not on O2
VO2 >10 ml/kg/min
MCC of hypoxemia after pulmonary resection - correct answer V/Q mismatch from atelectasis (shunt)
MCC of hypercarbia after pulmonary resection - correct answer alveolar hypoventilation (poor minute
ventilation RR x TV)
MC nerve injury after pulmonary resection - correct answer brachial plexus injuries
How can common peroneal nerve injuries be avoided durin pulmonary resection? - correct answer flex
dependent leg
Most common resection resulting in persistent air leak - correct answer segmentectomy/wedge
MC resection resulting in atelectasis - correct answer lobectomy
MC resection resulting in arrhythmias - correct answer pneumonectomy (R MC)
MC resection resulting in postop TEF - correct answer pneumonectomy (R MC)
MC resection resulting in postop bronchopleural fistula - correct answer pneumonectomy (R MC)
MC resection resulting in mortality - correct answer pneumonectomy (R MC)
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